Combination Therapy for Rare Dermal Sarcoma Effective, Avoids Radical Surgery

Combined treatment involving surgery and radiotherapy is a reasonablealternative to surgery alone in high-risk patients with dermato-fibrosarcomaprotruberans (DFSP), Canadian researchers reported at the AmericanSociety for Therapeutic Radiology and Oncology (ASTRO) meeting.

Dermatofibrosarcoma protruberans is an uncommon, low-grade sarcomaof the dermis and subcutis. Primary surgery is the preferred treatment;however, wide surgical clearance in certain sites may result incosmetic and/or functional loss.

For their study, Brian O'Sullivan, MD, and his colleagues at thePrincess Margaret Hospital, Toronto, reviewed all 45 DFSP casesreferred to their radiation oncology department between August,1958, and March, 1994. The tumors originated in the extremitiesin 16 patients, the head and neck in 17 cases, and the torso in12.

They found that excellent control rates were achievable even inhigh-risk cases. Their results showed local control in 17 of 19such cases, for a rate of 89%.

Dr. O'Sullivan, associate professor of radiation oncology, Universityof Toronto, emphasized that surgery is the recommended initialapproach in all cases of DFSP, with the expectation that all caseswill be controlled with margins greater than or equal to 1 cm.

However, adjuvant radiotherapy should be considered for microscopicresiduum--especially in locations where cosmesis or function wouldbe compromised by radical surgery--and in select sites when therisk of recurrence is high and there is potential for significantmorbidity from tumor relapse or subsequent surgery.

In this retrospective study, this approach to microscopic residualdisease, yielded the same impressive extent of control evidentin other soft-tissue sarcomas, he noted.